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Endocrine clinical case presentation (Thyroid disease)
- 2. Subjective 9 year old girl • Fever > 38.5 grade and abdominal pain started 5 days ago • Vomiting • Palpitation (HR 114) • Diarrhea • Hematuria Medical history • Tonsillectomy sep 2016 • Asthma (controlled) • Graves disease Dec 2016 (uncontrolled) Medication • Carbimazole tabs 5mg • Nexazole 20mg • Singulair 5mg
- 3. Birth history • Normal delivery, born 37 weeks • Hyperemesis Gravidarum • Birth weight 7.6 pound Family history • Grandmother with gravis disease • Mother with hypothyroidism • Sister with asthma • Aunt with cystic fibrosis Social history • Mother smoke • Like piano and swim
- 4. Objective Vital sign RR: 20 , Po2: 97 , HR: 95 , Temp: 36.5 , weight: 28.4 kg Physical exam Inspection: eye slightly bulging, goiter Palpation: abdomen soft no tenderness Auscultation: lung are clear and heart is normal Further exam Urine culture: non significant Blood test: 14/12/2017: Free T3: 5.93 high, Free T4: 9.3 low , TSH: 0.03 low 28/12/2017 : Free T3: 4.79high , Free T4: 5.2 low, TSH: 1.19
- 5. Evaluation • UTI • Appendicitis • Viral Infection PLAN • Stop antibiotic
- 6. Thyroid disease in children Congenital Hypothyroidism • Affect infants at birth • 1 in 4000 live born babies • Loos of thyroid function - absent • Delayed treatment – growth and development defects • Heelprick blood sample- assess thyroid hormone level. Hyperthyroidism in newborns • Thyroid stimulating antibodies cross the placenta – produce too much thyroid hormone. • No treatment maybe necessary – low antibodies
- 7. Hashimoto’s thyroiditis • Most common of hypothyroidism in children • Occur at any age – symptoms develop very slowly. • Thyroid gland – underactive • Laboratory diagnosis; T3, T4 decrease and TSH increase
- 8. graves disease Most common form of hyperthyroidism in children. Etiology: • Excessive thyroid hormone production, caused by thyrotropin receptor-stimulaing antibodies (TRS-Ab) • Girls > boys • Increase risk for other autoimmune disorders
- 10. Diagnosis: Laboratory test: • TSH – low • Free T4 – high • Free T3 – high • Antibodies Non-laboratory tests: • Radioactive iodine uptake- uptake is high • Ultrasound Treatment: • Beta blockers – reduce HR, sweating and anxiety • Anti-thyroid drugs – reduce thyroid hormone production . E.g. methimazole • Large dose of radioactive iodine – destroy most of thyroid gland • Surgery - remove thyroid gland hormone replacement medication
- 11. References • https://emedicine.medscape.com/article/120619- overview#a6 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010 678/ • https://www.mayoclinic.org/diseases- conditions/graves-disease/symptoms-causes/syc- 20356240 • Illustrated textbook of pediatrics
Editor's Notes
- General impression: Stable, alert, eyes slightly bulging Goiter Physical exam: Lung and heart; no abnormality Abdomen is soft no tenderness Further exam: Urine culture non significant
- It is an autoimmune condition that affects thyroid function, causing enlargement and over activity of thyroid is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause. Addison disease, insulin-dependent diabetes mellitus, celiac disease SLE and pernicious anemia